Chapter 26 Upper Respiratory

A patient develops epistaxis upon removal of a nasogastric tube. What action should the nurse take? a. Pinch the soft part of the nose b. Position the patient on their side c. Have the patient hyperextend the neck d. Apply an ice pack to the back of the neck

a. Pinch the soft part of the nose

During preoperative teaching for the patient scheduled for a total laryngectomy, what should the nurse include? a. The postoperative use of nonverbal communication techniques b. Techniques that will be used to alleviate a dry mouth and prevent stomatitis c. The need for frequent, vigorous coughing in the first 24 hours postoperatively d. Self-help groups and community resources for patients with cancer of the larynx

a. The postoperative use of nonverbal communication techniques

A nurse obtains a health history from a patient who has a 35 pack-year smoking history. The patient complains of hoarseness and tightness in the throat and difficulty swallowing. Which question is important for the nurse to ask? a. "How much alcohol do you drink in an average week?" b. "Do you have a family history of head or neck cancer?" c. "Have you had frequent streptococcal throat infections?" d. "Do you use antihistamines for upper airway congestion?"

a. "How much alcohol do you drink in an average week?"

The nurse completes discharge instructions for a patient with a total laryngectomy. Which statement by the patient indicates that additional instruction is needed? a. "I must keep the stoma covered with an occlusive dressing." b. "I need to have smoke and carbon monoxide detectors installed." c. "I can participate in my prior fitness activities except swimming." d. "I should wear a Medic-Alert bracelet to identify me as a neck breather."

a. "I must keep the stoma covered with an occlusive dressing."

Which statement by the patient indicates that teaching has been effective for a patient scheduled for radiation therapy of the larynx? a. "I will need to buy a water bottle to carry with me." b. "I should not use any lotions on my neck and throat." c. "Until the radiation is complete, I may have diarrhea." d. "Alcohol-based mouthwashes will help clean my mouth."

a. "I will need to buy a water bottle to carry with me."

A 36 year old patient with Type 1 Diabetes Mellitus asks the nurse whether an influenza vaccine is necessary every year. What is the best response by the nurse? a. "You should get the inactivated influenza vaccine that is injected every year." b. "Only healthcare workers in contact with high-risk patients should be immunized every year" c. "An annual vaccination is not necessary because previous immunity will protect you for several years." d. "Antiviral drugs, such as zanamivir (Relenza), eliminate the need for vaccine except in the older adult."

a. "You should get the inactivated influenza vaccine that is injected every year."

The nurse is reviewing the medical records for five patients who are scheduled for their yearly physical examinations in September. Which patients should receive the inactivated influenza vaccination? Select all that apply a. A 76-yr-old nursing home resident b. A 36-yr-old female patient who is pregnant c. A 42-yr-old patient who has a 15 pack-year smoking history d. A 30-yr-old patient who takes corticosteroids for rheumatoid arthritis e. A 24-yr-old patient who has allergies to penicillin and cephalosporins

a. A 76-yr-old nursing home resident b. A 36-yr-old female patient who is pregnant d. A 30-yr-old patient who takes corticosteroids for rheumatoid arthritis e. A 24-yr-old patient who has allergies to penicillin and cephalosporins

When assessing the patient on return to the surgical unit following a total laryngectomy and radical neck dissection, what would the nurse expect to find? a. A closed-wound drainage system b. A nasal endotracheal tube in place c. A nasogastric tube with orders for tube feedings d. A tracheostomy and mechanical ventilation

a. A closed-wound drainage system

Which patient in the ear, nose, and throat (ENT) clinic should the nurse assess first? a. A patient who is complaining of a sore throat and has a muffled voice b. A patient who has a "scratchy throat" and a positive rapid strep antigen test c. A patient who is receiving radiation for throat cancer and has severe fatigue d. A patient with a history of a total laryngectomy whose stoma is red and inflamed

a. A patient who is complaining of a sore throat and has a muffled voice

A patients tracheostomy tube becomes dislodged with vigorous coughing. The first action by the nurse is to a. Attempt to replace the tube b. Notify the healthcare provider c. Place the patient in high Fowler's position d. Ventilate the patient with a manual resuscitation bag until the health care provider arrives

a. Attempt to replace the tube

After being hit by a baseball, a patient arrives in the emergency department with a possible nasal fracture. Which finding by the nurse is most important to report to the health care provider? a. Clear nasal drainage b. Complaint of nasal pain c. Bilateral nose swelling and bruising d. Inability to breathe through the nose

a. Clear nasal drainage

The clinic nurse is teaching a patient with acute sinusitis. Which interventions should the nurse plan to include in the teaching session? Select all that apply a. Decongestants can be used to relieve swelling. b. Blowing the nose should be avoided to decrease the nosebleed risk. c. Taking a hot shower will increase sinus drainage and decrease pain. d. Saline nasal spray can be made at home and used to wash out secretions. e. You will be more comfortable if you keep your head in an upright position.

a. Decongestants can be used to relieve swelling. c. Taking a hot shower will increase sinus drainage and decrease pain. d. Saline nasal spray can be made at home and used to wash out secretions. e. You will be more comfortable if you keep your head in an upright position.

While the nurse is feeding a patient, the patient appears to choke on the food. Which symptoms indicate to the nurse that the patient has a partial airway obstruction? Select all that apply a. Stridor b. Cyanosis c. Wheezing d. Bradycardia e. Rapid respiratory rate

a. Stridor b. Cyanosis c. Wheezing

In planning the care for a patient with a tracheostomy who has been stable and is to be discharged later in the day, the RN may delegate which interventions to the LPN? Select all that apply a. Suction the tracheostomy b. Provide tracheostomy care c. Determine the need for suctioning d. Assess the patient's swallowing ability e. Teach the patient about home tracheostomy care

a. Suction the tracheostomy b. Provide tracheostomy care c. Determine the need for suctioning

The nurse is caring for a hospitalized older patient who has nasal packing in place after a nosebleed. Which assessment finding will require the most immediate action by the nurse? a. The oxygen saturation is 89%. b. The nose appears red and swollen. c. The patient reports level 8 (0 to 10 scale) pain. d. The patient's temperature is 100.1° F (37.8° C).

a. The oxygen saturation is 89%

The nurse assumes care of a patient who just returned from surgery for a total laryngectomy and radical neck dissection and notes the following problems. In which order should the nurse address the problems? Select all that apply a. The patient is in a side-lying position with the head of the bed flat. b. The patient is coughing blood-tinged secretions from the tracheostomy. c. The nasogastric (NG) tube is disconnected from suction and clamped off. d. The wound drain in the neck incision contains 200 mL of bloody drainage.

a. The patient is in a side-lying position with the head of the bed flat. b. The patient is coughing blood-tinged secretions from the tracheostomy. c. The nasogastric (NG) tube is disconnected from suction and clamped off. d. The wound drain in the neck incision contains 200 mL of bloody drainage.

The nurse is caring for a mechanically ventilated patient with a cuffed tracheostomy tube. Which action by the nurse would determine if the cuff has been properly inflated? a. Use a hand-held manometer to measure cuff pressure. b. Review the health record for the prescribed cuff pressure. c. Suction the patient through a fenestrated inner cannula to clear secretions. d. Insert the decannulation plug before removing the nonfenestrated inner cannula.

a. Use a hand-held manometer to measure cuff pressure

The patient has been diagnosed with an early vocal cord malignancy. The nurse explains that usual treatment includes a. radiation therapy that preserves the quality of the voice b. a hemilaryngectomy that prevents the need for a tracheostomy c. a radical neck dissesction that removes possible sites of metastasis d. a total laryngectomy to prevent development of second primary cancers

a. radiation therapy that preserves the quality of the voice

The nurse discusses management of upper respiratory infections (URIs) with a patient who has acute sinusitis. Which statement by the patient indicates that additional teaching is needed? a. "I will drink lots of juices and other fluids to stay well hydrated." b. "I can use nasal decongestant spray until the congestion is gone." c. "I can take acetaminophen (Tylenol) to treat my sinus discomfort." d. "I will watch for changes in nasal secretions or the sputum that I cough up."

b. "I can use nasal decongestant spray until the congestion is gone."

What is the most normal functioning method of speech restoration for the patient with a total laryngectomy? a. Esophageal speech b. A transesophageal puncture c. An electrolarynx held to the neck d. An electrolarynx placed in the motuh

b. A transesophageal puncture

Which action should the nurse take first when a patient develops epistaxis? a. Pack the affected nare tightly with an epistaxis balloon. b. Apply squeezing pressure to the nostrils for 10 minutes. c. Obtain silver nitrate that may be needed for cauterization. d. Instill a vasoconstrictor medication into the affected nare.

b. Apply squeezing pressure to the nostrils for 10 minutes

The nurse obtains the following assessment data on an older patient who has influenza. Which information will be most important for the nurse to communicate to the health care provider? a. Fever of 100.4° F (38° C) b. Diffuse crackles in the lungs c. Sore throat and frequent cough d. Myalgia and persistent headache

b. Diffuse crackles in the lungs

When obtaining a health history from a patient with possible cancer of the mouth, what would the nurse expect the patient to report? a. Long-term denture use b. Heavy tobacco and/or alcohol use c. Persistent swelling of the neck and face d. Chronic herpes simplex infections of the mouth and lips

b. Heavy tobacco and/or alcohol use

What should the nurse include in discharge teaching for the patient with a total laryngectomy? a. How to use esophageal speech to communicate b. How to use a mirror to suction the tracheostomy c. The necessity of never covering the laryngectomy stoma d. The need to use baths instead of showers for personal hygeine

b. How to use a mirror to suction the tracheostomy

What does the nurse teach the patient with intermittent allergic rhinitis is the most effective way to decrease allergic symptoms? a. Undergo weekly immunotherapy b. Identify and avoid triggers of the allergic reaction c. Use cromolyn nasal spray prophylactically year round d. Use OTC antihistamines and decongestants during an acute attack

b. Identify and avoid triggers of the allergic reaction

The nurse plans to teach a patient how to manage allergic rhinitis. Which information should the nurse include in the teaching plan? a. Using oral antihistamines for 2 weeks before the allergy season may prevent reactions. b. Identifying and avoiding environmental triggers are the best way to prevent symptoms. c. Frequent hand washing is the primary way to prevent spreading the condition to others. d. Corticosteroid nasal sprays will reduce inflammation, but systemic effects limit their use.

b. Identifying and avoiding environmental triggers are the best way to prevent symptoms.

What is included in the nursing care of the patient with a cuffed tracheostomy tube? a. Change the tube every 3 days b. Monitor cuff pressure every 8 hours c. Perform mouth care every 12 hours d. Assess ABGs every 8 hours

b. Monitor cuff pressure every 8 hours

During care of a patient with a cuffed tracheostomy, the nurse notes that the tracheostomy tube has an inner cannula. To care for the tracheostomy appropriately, what should the nurse do? a. Deflate the cuff, then remove and suction the inner cannula b. Remove the inner cannula and replace it per institutional guidelines c. Remove the inner cannula if the patient shows signs of airway obstruction d. Keep the inner cannula in place at all times to prevent dislodging of the tracheostomy tube

b. Remove the inner cannula and replace it per institutional guidelines

Which nursing action could the registered nurse (RN) working in a skilled care hospital unit delegate to an experienced licensed practical/vocational nurse (LPN/LVN) caring for a patient with a permanent tracheostomy? a. Assess the patient's risk for aspiration. b. Suction the tracheostomy when directed. c. Teach the patient to provide tracheostomy self-care. d. Determine the need for tracheostomy tube replacement.

b. Suction the tracheostomy when directed

When assessing a patient with a sore throat, the nurse notes anterior cervical lymph node swelling, a temperature of 101.6° F (38.7° C), and yellow patches on the tonsils. Which action will the nurse anticipate taking? a. Teach the patient about the use of expectorants. b. Use a swab to obtain a sample for a rapid strep antigen test. c. Discuss the need to rinse the mouth out after using any inhalers. d. Teach the patient to avoid nonsteroidal antiinflammatory drugs (NSAIDs).

b. Use a swab to obtain a sample for a rapid strep antigen test

A patient scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx asks the nurse, "Will I be able to talk normally after surgery?" What is the most accurate response by the nurse? a. "You will breathe through a permanent opening in your neck, but you will not be able to communicate orally." b. "You won't be able to talk right after surgery, but you will be able to speak again after the tracheostomy tube is removed." c. "You will have a permanent opening into your neck, and you will need rehabilitation for some type of voice restoration." d. "You won't be able to speak as you used to, but there are artificial voice devices that will give you the ability to speak normally."

c. "You will have a permanent opening into your neck, and you will need rehabilitation for some type of voice restoration."

What is an advantage of a tracheostomy over an endotracheal (ET) tube for long-term management of an upper airway obstruction? a. A tracheostomy is safer to perform in an emergency b. An ET tube has a high risk of tracheal pressure necrosis c. A tracheostomy tube allows for more comfort and mobility d. An ET tube is more likely to lead to lower respiratory tract infection

c. A tracheostomy tube allows for more comfort and mobility

A patient with a tracheostomy has a new order for a fenestrated tracheostomy tube. Which action should the nurse include in the plan of care in collaboration with the speech therapist? a. Leave the tracheostomy inner cannula inserted at all times. b. Place the decannulation cap in the tube before cuff deflation. c. Assess the ability to swallow before using the fenestrated tube. d. Inflate the tracheostomy cuff during use of the fenestrated tube.

c. Assess the ability to swallow before using the fenestrated tube

After a laryngectomy, a patient coughs violently during suctioning and dislodges the tracheostomy tube. Which action should the nurse take first? a. Arrange for arterial blood gases to be drawn immediately. b. Cover stoma with sterile gauze and ventilate through stoma. c. Attempt to reinsert the tracheostomy tube with the obturator in place. d. Assess the patient's oxygen saturation and notify the health care provider.

c. Attempt to reinsert the tracheostomy tube with the obturator in place

A nurse is caring for a patient who has had a total laryngectomy and radical neck dissection. During the first 24 hours after surgery what is the priority nursing action? a. Monitor the incision for bleeding. b. Maintain adequate IV fluid intake. c. Keep the patient in semi-Fowler's position. d. Teach the patient to suction the tracheostomy.

c. Keep the patient in semi-Fowler's position

The nurse has just auscultated coarse crackles bilaterally on a patient with a tracheostomy tube in place. If the patient is unsuccessful in coughing up secretions, what action should the nurse take? a. Encourage increased incentive spirometer use. b. Encourage the patient to increase oral fluid intake c. Put on sterile gloves and use a sterile catheter to suction. d. Preoxygenate the patient for 3 minutes before suctioning

c. Put on sterile gloves and use a sterile catheter to suction

A patient who had a total laryngectomy has a nursing diagnosis of hopelessness related to loss of control of personal care. Which information obtained by the nurse indicates that this identified problem is resolving? a. The patient allows the nurse to suction the tracheostomy. b. The patient's spouse provides the daily tracheostomy care. c. The patient asks how to clean the tracheostomy stoma and tube. d. The patient uses a communication board to request "No Visitors."

c. The patient asks how to clean the tracheostomy stoma and tube

What are characteristics of a fenestrated tracheostomy tube? Select all that apply a. The cuff passively fills with air b. Cuff pressure monitoring is not required c. It has two tubings with one opening just above the cuff d. Patient can speak with an attached air source with the cuff inflated e. Airway obstruction is likely if the exact steps are not followed to produce speech f. Airflow around the tube and through the window allows speech when the cuff is deflated and the plug is inserted

e. Airway obstruction is likely if the exact steps are not followed to produce speech f. Airflow around the tube and through the window allows speech when the cuff is deflated and the plug is inserted

A patient with acute pharyngitis is seen at the clinic with a fever and severe throat pain that affects swallowing. On inspection, the throat is reddened and edematous with patchy yellow exudates. The nurse anticipates that interprofessional management will include a. treatment with antibiotics b. treatment with antifungal agents c. a throat culture or rapid strep antigen test d. treatment with medication only if the pharyngitis does not resolve in 3 to 4 days

c. a throat culture or rapid strep antigen test

The nurse teaches a patient about discharge instructions after a rhinoplasty. Which statement, if made by the patient, indicates that the teaching was successful? a. "My nose will look normal after 24 to 48 hours." b. "I can take 800 mg ibuprofen every 6 hours for pain." c. "I will remove and reapply the nasal packing every day." d. "I will elevate my head for 48 hours to minimize swelling."

d. "I will elevate my head for 48 hours to minimize swelling."

During assessment of the patient with a viral upper respiratory infection, the nurse recognizes that anitbiotics may be indicated based on what finding? a. Cough and sore throat b. Copious nasal drainage c. Temperature of 100F (38C) d. Dyspnea and severe sinus pain

d. Dyspnea and severe sinus pain

A patient arrives in the ear, nose, and throat clinic complaining of a piece of tissue being "stuck up my nose" and with foul-smelling nasal drainage from the right nare. Which action should the nurse take first? a. Notify the clinic health care provider. b. Obtain aerobic culture specimens of the drainage. c. Ask the patient about how the cotton got into the nose. d. Have the patient occlude the left nare and blow the nose.

d. Have the patient occlude the left nare and blow the nose.

The nurse receives an evening report on a patient who underwent posterior nasal packing for epistaxis earlier in the day. What is the FIRST patient assessment the nurse should make? a. Patient's temperature b. Level of the patient's pain c. Drainage on the nasal dressing d. Oxygen saturation by pulse oximetry

d. Oxygen saturation by pulse oximetry

The nurse is caring for a patient who has acute pharyngitis caused by Candida albicans. Which action is appropriate for the nurse to include in the plan of care? a. Assess patient for allergies to penicillin antibiotics. b. Teach the patient to sleep in a warm, dry environment. c. Avoid giving the patient warm food or warm liquids to drink. d. Teach patient to "swish and swallow" prescribed oral nystatin

d. Teach patient to "swish and swallow" prescribed oral nystatin

Which actions prevent the dislodgement of a tracheostomy tube in the first 3 days after its placement? Selecat all that apply a. Provide tracheostomy care every 24 hours. b. Keep the patient in the semi-Fowler position at all times. c. Keep a same size or larger replacement tube at the bedside. d. Tracheostomy ties are not changed for 24 hours after tracheostomy procedure. e. Suction the tracheostomy tube when there is a moist cough or a decreased SpO2. f. A physician performs the first tube change, no sooner than 7 days after the tracheostomy.

d. Tracheostomy ties are not changed for 24 hours after tracheostomy procedure e. Suction the tracheostomy tube when there is a moist cough or a decreased SpO2